Ezel ERSEN, Ahmet DEMİRKAYA, Bilgi BACA, İsmail HAMZAOĞLU, Tayfun KARAHASANOĞLU, Ziya SALİHOĞLU, Şener DEMİROLUK

Effects of positioning and ventilation strategy on the parameters of respiratory mechanics and blood gases during video-assisted thoracoscopic esophagectomy

Amaç: Bu çalışmada video-yardımlı torakoskopik (VYT) özofajektomi süresince hasta pozisyonu ve ventilasyon stratejisinin, solunum mekaniği ve kan gazları üzerine etkileri değerlendirildi.Çalışma planı: Etik kurul onayı alındıktan sonra fiziksel olarak ASA I (Society of Anesthesiologists I) veya II sınıfında olan özofagus kanseri nedeniyle VYT-özofajektomi ameliyatı uygulanan dokuz hasta, (2 kadın 7 erkek; ort. yaş 60 yıl; dağılım 39-74 yıl) çalışmaya dahil edildi. Standart genel anestezi uygulandı. Dinamik respiratuvar kompliyans, hava yolu direnci, inspiratuvar tepe basıncı monitörize edildi. Ölçümler beş ayrı zamanda kaydedildi; entübasyon sonrası 10. dakika (Entübasyon: T1, kontrol), sol lateral dekübit pozisyonu sonrası 10. dakika (Sol lateral: T2), sol lateral dekübit pozisyonunda tek akciğer ventilasyonunu sonrası 10. dakika (Tek akciğerbaşlangıç: T3), tek akciğer ventilasyonu sona ermeden önceki 10. dakika (Tek akciğer-son: T4) ve yüzüstü pozisyonu sonrası 10. dakika (Yüzüstü: T5). Arteryal kan gazı örnekleri de aynı aralıklarla alındı.Bulgular: Dinamik respiratuvar kompliyans kayıtları T1, T2, T3, T4 ve T5’te sırasıyla; 66±12 ml. cm. H2O-1, 53±8 ml. cm. H2O-1, 49±8 ml. cm. H2O-1, 48±8 ml. cm. H2O-1 ve 52±11 ml. cm. H2O-1 olarak bulundu. Değişimler T2, T3, T4 ve T5’te anlamlı bulundu (p

Video-yardımlı torakoskopik özofajektomi sırasında ventilasyon stratejisi ve pozisyon değişikliğinin solunum mekaniği ve kan gazı parametrelerine etkileri

Background: In this study, the effects of positioning and ventilation strategy on respiratory mechanics and blood gases throughout video-assisted thoracoscopic (VAT) esophagectomy were evaluated.Methods: After obtaining approval from the ethics committee, nine patients (2 females, 7 males; mean age 60 years; range 39 to 74 years) who underwent a VATesophagectomy for esophageal cancer with ASA I (Society of Anesthesiologists I) or II physical classification were included in the study. Standard general anesthesia was performed. Dynamic respiratory compliance, airway resistance, and peak inspiratory pressure were monitored. Measurements were recorded in five periods; 10 minutes after intubation (Intubation: T1, control), 10 minutes after left lateral decubitus position (Left lateral: T2), 10 minutes after single lung ventilation with left lateral decubitus position (Single lung-initiation: T3), 10 minutes before single lung ventilation ends (Single lung-end: T4), and 10 minutes after supine position (Supine: T5). Samples of arterial blood gases were obtained at the same periods.Results: Dynamic respiratory compliance records were 66±12 ml. cm. H2O-1, 53±8 ml. cm. H2O-1, 49±8 ml. cm. H2O-1, 48±8 ml. cm. H2O-1 and 52±11 ml. cm. H2O-1, in T1, T2, T3, T4 and T5, respectively. The changes were significant in T2, T3, T4 and T5 (p

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